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Victoria Fan is an assistant professor at the University of Hawaii at Manoa and visiting fellow at the Center for Global Development. She is a health economist, focused on evaluating the effectiveness and efficiency of health policies and interventions. From 2011 to 2014, Fan was a research fellow at the Center for Global Development, analyzing value for money of global health policy. She has worked with different nongovernmental organizations in Asia (BRAC, SEWA, Tzu Chi) and at different units at Harvard University (Harvard Initiative for Global Health, Harvard Global Equity Initiative, Harvard University Program for Health Care Financing). She has served as a consultant for the China Medical Board, World Bank and World Health Organization and on studies supported by the Rockefeller Foundation and the Bill & Melinda Gates Foundation. She was trained in mechanical engineering at MIT and epidemiology, health systems, and health economics at Harvard T.H. Chan School of Public Health.

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More From Victoria Fan

Should patients be paid to seek lifesaving services? Should patients receive lifesaving service free of charge? While these two questions have typically been studied separately, we decided to take a look at them together. In our new study, published in Health Services Research, we find that not charging pregnant women for health services mattered less than paying them.

India matters for global health. It accounts not only for about one-fifth of the global population, but also one-fifth of the global disease burden. Yet the Indian government spends only 1 percent of its GDP on public health—a paltry amount compared to what other large, federal countries like Brazil and China allocate (4.7 percent and 3.1 percent, respectively). This has a direct impact on Indian citizens who pay more out-of-pocket for health care than citizens in any other G20 country.

Most money and responsibility for health in large federal countries like India rests with subnational governments — states, provinces, districts, and municipalities. The policies and spending at the subnational level affect the pace, scale, and equity of health improvements in countries that account for much of the world’s disease burden: India, Indonesia, Nigeria, and Pakistan.

In his early days as India’s new prime minister, Narendra Modi has shown remarkable leadership in all sectors, including health, for which he’s articulated his vision to create a Swasth Bharat, a Healthy India. Combined with two major policy windows—the proposed restructuring of the Planning Commission and the report of the 14th Finance Commission expected by the end of the year—the policy reforms under the ruling National Democratic Alliance (NDA)’s mandate of “Universal Health Assurance for All” have the potential to be a game-changer for India’s neglected public health system.

For decades, primary health care in China has been practically forgotten. Most people in China today seek care directly at hospitals rather than local village clinics. With hospitals overwhelmed by patients for even minor conditions, doctors provide low quality care. But a new Health Economics study provides hope that it is possible to shift utilization from hospitals back down to village clinics – and back to the people.

In recent years, the interdisciplinary nature of global health has blurred the lines between medicine and social science. As medical journals publish non-experimental research articles on social policies or macro-level interventions, controversies have arisen when social scientists have criticized the rigor and quality of medical journal articles.

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This report offers a strategy for the Global Fund to get more health for the money by focusing more on results, maximizing cost-effectiveness, and systematically measuring performance throughout its operations.

The authors of this working paper analyze the effects of the Aarogyasri health insurance program deployed in 2007 in Andhra Pradesh to reduce catastrophic health expenditures in households below the poverty line.

Most money and responsibility for health in large federal countries like India rests with subnational governments — states, provinces, districts, and municipalities. The policies and spending at the subnational level affect the pace, scale, and equity of health improvements in countries that account for much of the world’s disease burden: India, Indonesia, Nigeria, and Pakistan.

In recent years, the interdisciplinary nature of global health has blurred the lines between medicine and social science. As medical journals publish non-experimental research articles on social policies or macro-level interventions, controversies have arisen when social scientists have criticized the rigor and quality of medical journal articles.

In just five years, India’s Rashtriya Swasthya Bima Yojana (RSBY, translated as “National Health Insurance Programme”) has expanded health-care access. Where dozens of “microinsurance” and NGO pilots failed to scale up, RSBY has already provided more than 110 million people (almost 10 percent of India’s population) with heavily subsidized health insurance, providing up to US$550 annually to finance secondary hospital care. Although the research evidence on RSBY is still developing, early results are encouraging: increased utilization and hospitalization; some indication of reduced out-of-pocket payments for healthcare; and a means of identification with a clearly linked entitlement. While RSBY still faces challenges, particularly on the quality of care of increased hospitalization rates, RSBY has aligned incentives for both public and private hospitals to deliver better care.

In this essay, Victoria Fan tells the story of how RSBY came into being under the leadership of Anil Swarup—whom she describes as an “unassuming officer of the Indian Administrative Service”—and outlines the program’s early successes and opportunities for future progress.

Photo: EU Humanitarian Aid and Civil Protection / cc
As we approach the third anniversary of the Haiti earthquake, reconstruction and recovery efforts continue—as does the debate within the development community: Why aren’t recovery efforts moving faster? Are international donors and NGOs helping or hurting recovery? Can traditional aid work amidst Haiti's weak government institutions? Are there alternative approaches that would be better?
CGD’s efforts on Haiti’s challenges continue. Here are our recent suggestions for alternative approaches in Haiti, as well as previous innovative ideas that remain relevant:
1) Cash Transfers for Haitians
Vijaja Ramachandran, Senior Fellow
Hurricane Sandy has exacerbated the food crisis in Haiti, as well as increased the incidence of water-based diseases, like cholera. Donors have responded accordingly, but donors must also take steps to improve the quality of their assistance to Haiti. Cash transfers are often the best way to empower disaster victims to rebuild their lives, while also generating demand that fuels the local economy. I recommend the World Food Programme’s Cash for Assets program as an effective model to be implemented for Haitians to purchase much-needed goods and services, in addition to coordinated humanitarian relief.
2) Improve Transparency and Accountability
Vijaya Ramachandran, Senior Fellow, and Julie Walz, Policy Analyst
Since the 2010 earthquake, over $6 billion has been disbursed in official aid to help the people of Haiti. Almost 90 percent of aid has gone to international NGOs and private contractors (9.5 percent has gone to the Government of Haiti and .4 percent to Haitian NGOs and businesses). Yet, there’s very little transparency about how this money is spent. Funders should require more evaluations of NGO and contractor activities, and also report their activities in the IATI format. Further, the Government of Haiti should be encouraged to procure services through competitive bidding. This would not only increase accountability of NGOs and contractors providing the services but also enable the Haitian government to build control over the process.
3) Increase Local Procurement
Vijaya Ramachandran, Senior Fellow, and Julie Walz, Policy Analyst
Out of every $100 spent by the US Government for reconstruction following the 2010 earthquake in Haiti, only $1.35 went directly to Haitian companies. The current US development strategy focuses on stimulating economic activity and pledges support to Micro, Small, and Medium Enterprises along with the development of Caracol Industrial Park. Yet, a key tool is missing in the strategy to build economic security and jobs in Haiti – buying from local businesses.
4) Better Haiti Aid: MigrationMichael Clemens, Senior Fellow
“The U.S. government added Haiti to the list of more than 50 countries eligible to participate in the H-2 visa program for temporary and seasonal workers, ending a longstanding policy of excluding Haitians from America’s largest temporary employment-based visa program. This is wonderful news for Haitians and Americans. It has the potential to unlock hundreds of millions of dollars in new economic opportunity for Haitian workers and their families—at no cost to the U.S. or Haitian governments, and with no increase in overall U.S. immigration. This seemingly tiny change has vast economic potential. Given the huge wage differences (an estimated $19,000 in additional annual income per Haitian worker), if just 2,000 Haitians are permitted to work as H-2 workers in the United States each year, over the course of 10 years, that’s $400 million in additional, new income for Haitian families. That’s equal in size to the entire U.S. post-earthquake budget for reconstruction in Haiti. Building on this great work, the US should consider a Haitian Family Reunification Parole Program. Haitians who have been approved for US permanent residency must sometimes wait as much as 11 years in Haiti to receive their green cards. A parole program would permit some of them to wait for their green cards in the United Stated instead.”
5) Cholera in Haiti: The Blame GameVictoria Fan, Research Fellow, and Richard Cash, Senior Lecturer on Global Health, Harvard School of Public Health
“Since October 2010, Haiti has struggled to control a deadly cholera outbreak—on top of ongoing recovery efforts from the devastating earthquake in January 2010. In December 2011, a group of lawyers in Haiti, on behalf of some 15,000 victims of cholera, sued the United Nations for $50,000 for each victim and double that for families of those who died. Focusing on these immediate objects of blame are of epidemiologic interest, but deflect attention away from the country experiencing the disease, and in this case, unable to control the spread. In a country where aid agencies and NGOs play major roles relative to the government, this outbreak should draw attention not only to immediate causes but more importantly to the long-term failure by every involved party and to the urgency of improving Haiti’s water and sanitation as soon as possible.”
Click here and here to see earlier lists of alternative development ideas for Haiti, featuring more ideas and commentary on post-quake development efforts.

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In recent years, the interdisciplinary nature of global health has blurred the lines between medicine and social science. As medical journals publish non-experimental research articles on social policies or macro-level interventions, controversies have arisen when social scientists have criticized the rigor and quality of medical journal articles.

The authors of this working paper analyze the effects of the Aarogyasri health insurance program deployed in 2007 in Andhra Pradesh to reduce catastrophic health expenditures in households below the poverty line.